MEDICARE: JOURNEY MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician	301823	LA

General Provider Information

NPI Number	:	1841782208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY MEDICAL LLC

Provider Business Mailing Address
First Line	:	12025 JUSTICE AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5327
Country	:	US
Telephone Number	:	225-218-4677
Fax Number	:	225-218-4677

Provider Business Practice Location Address
First Line	:	11924 JUSTICE AVE STE B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2372
Country	:	US
Telephone Number	:	225-218-4677
Fax Number	:	225-218-4677

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELIA HECTOR
Credential	:
Telephone Number	:	225-218-4677

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	07/19/2019

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Directions to “JOURNEY MEDICAL LLC ” Practice Location

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